Journal of Sex & Marital Therapy
ISSN: 0092-623X (Print) 1521-0715 (Online) Journal homepage: http://www.tandfonline.com/loi/usmt20
Sex is psychosomatic To cite this article: (1975) Sex is psychosomatic, Journal of Sex & Marital Therapy, 1:4, 275-276, DOI: 10.1080/00926237508403701 To link to this article: http://dx.doi.org/10.1080/00926237508403701
Published online: 14 Jan 2008.
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Date: 20 June 2016, At: 08:21
Journal of Sex & Marital Therapy Vol. 1 , No. 4, Summer 1975
Journal of Sex & Marital Therapy 1975.1:275-276.
SEX IS PSYCHOSOMATIC Although exquisitely sensitive to psychic forces, the sexual response ultimately depends on the physical integrity of the sexual system. N o matter what the emotional state of a man may be, erection is possible only if the penis is anatomically sound, if the pelvic circulation is adequate, if the central and autonomic nervous system innervation is intact, and if the hormonal environment is properly balanced. In fact, although in our society the psychogenic causes of sexual dysfunction are far more prevalent, physical determinants including some kinds of illness, hormonal deficiencies, and use of certain drugs contribute to the erectile and ejaculatory difficulties of many men. The female sexual response is somewhat less vulnerable t o physical impairment. Still, before treating a vaginismic or anorgasmic woman, one must rule out pelvic pathology, diabetes, drug usage, neurological disease, hormonal deficiencies, and other physical determinants. It is unconscionable to treat a patient for an alleged psychogenic disorder in the presence of physical pathology. Not only will this be a frustrating and disappointing endeavor, but sometimes the underlying organic factor can be remedied. Hormone and vitamin replacement, changes in antihypertensive medication, and penile implants, for example, can reverse physical problems in some dysfunctional patients. At times, of course, the damage is irreversible. In such cases the couple require not sex therapy but sex counseling. Organic causes of sexual dysfunction are often obscure, and surprisingly few physicians are skilled in their medical evaluation. A routine medical examination will screen out only the most obvious organic causes of sexual dysfunction, and will fail t o reveal more subtle and complicated etiologies. Diabetes and gross hormonal anatomical defects of the genitals are usually detected in routine medical examinations, but less obvious causes, such as use of antihypertensive medication, a low testosterone level in females, a high estrogen level in males, vitamin deficiency, and neuropathy, may be missed by the physician who is unsophisticated in this area. It is unfortunately a common experience for a patient t o be advised by his urologist or internist that “there is nothing physically wrong with you, it is all emotional,” only to have sleep studies reveal that his nocturnal erections are greatly diminished. (Incidentally, sleep studies-which are described in this issue of the journal-give promise of developing into an invaluable diagnostic 2 75
Journal of Sex & Marital Therapy 1975.1:275-276.
tool for determining the existence and amount, but not the etiology or mechanism, of organic impairment of the erectile response.) In evaluating a sexual dysfunction it is not a simple question of “Is it organic o r psychogenic?” Physical impairment of the sexual response is more likely to be partial than absolute. Antihypertensive medication, for example, or early diabetes in men does not generally produce complete impotence. The man may be able to erect with more vigorous stimulation, and often the ejaculatory response remains intact. Again, the couple wherein one partner has lost some function require sexual-rehabilitative counseling. Organically caused partial impairment may escalate into total dysfunction because of the negative emotional responses of one or both partners t o the disability. The failure of a diabetic man t o rapidly obtain a firm erection may cause him to develop performance anxiety and/or his wife to worry about her diminished attractiveness. These concerns will of course burden the already physically compromised response with an additional emotional component. Excellent results may be obtained with sex therapy in such cases. Sex therapy can be facilitated in all cases, but most especially with those who suffer an organic component, when the therapist conceptualizes the sexual reflexes as psychosomatic. (The same considerations apply to all emotional response and emotional illness, that is, psychosis is psychosomatic, emotions are psychosomatic.) A clear idea of the underlying pathophysiological process-be it functional anxiety or diabetic neuropathy or a combination of both-will help the therapist to formulate rational and effective therpauetic interventions.
H. S . K .